Medicine and Science from The BMJ

Although overuse in medicine is gaining increased attention, many questions remain unanswered. At the Preventing Overdiagnosis conference in Washington, Dan Morgan, associate professor at the University of Maryland School of Medicine, and Sanket Dhruva, research fellow at Yale University, propose an agenda for coordinated research to improve our understanding of the problem. Read the full agenda at: http://www.bmj.com/content/351/bmj.h4534

Hepatic encephalopathy constitutes a spectrum of neuropsychiatric abnormalities, beginning with subtle psychomotor changes and progressing to confusion with asterixis, somnolence, and then coma, arising in patients with impaired liver function. In this podcast, Tim Cross, a consultant hepatologist from the Royal Liverpool University Hospital, describes how to diagnose and manage the condition. We're also joined by Ralph Crawford, who suffers from hepatic encephalopathy, to talk about the burden of the disease and the treatment from a patient's perspective. Read the full review: http://www.bmj.com/content/351/bmj.h4187

Following on from the clinical review "Caring for sex workers", we spoke to the team at Open Doors, a sex worker outreach clinic in east London, run from the Homerton University Hospital NHS Foundation Trust. Kim Leveret and Anca Doczi join us to give practical advice on reaching out to sex workers, what barriers exist to them accessing care, and how to take a sex worker sexual history. Listen to the author of the clinical review, Michael Rekart, talk about the infectious disease side of sex worker health in our accompanying podcast: https://soundcloud.com/bmjpodcasts/sex-worker-health Read the full review: http://www.bmj.com/content/351/bmj.h4011 Practical advice for sex workers and health professionals, including links to Ugly Mugs: http://www.opendoors.nhs.uk/ The historic reasons for high abortion rates in Romania, from the journal of family planning and reproductive healthcare: https://soundcloud.com/bmjpodcasts/romanian-womens-fertility

Sex workers are unique population with specific health needs, caring for them can present non-specialists with a challenge, and there are important health promotion opportunities which should no be missed. Michael Rekart, clinical professor of infectious disease at the University of British Columbia, joins us to discuss his clinical review on caring for sex workers. Read the full article: http://www.bmj.com/content/351/bmj.h4011 Listen to outreach workers from Open Doors, a sex worker healthcare initiative in east London, give practical tips on caring for sex workers: https://soundcloud.com/bmjpodcasts/open-doors-for-sex-workers

Elder abuse is often the result of the organisation of health systems rather than the fault of individuals, argue Jolanda Lindenberg and Rudi Westendorp, two authors of a recent analysis paper. They call for system abuse to be acknowledged and addressed by incorporating older people’s views when designing health services. Read the full analysis: http://www.bmj.com/content/350/bmj.h2697

For decades research has shown that discrimination, harassment, and exclusion are pervasive experiences for staff from black and minority ethnic (BME) backgrounds in the National Health Service. In this podcast, the authors of a recent analysis article in The BMJ talk about the evidence for discrimination, what the NHS has done and is doing, and what has worked to promote equality in the wider world. Read their full analysis at: http://www.bmj.com/content/351/bmj.h3297

A recent review by the Australian National Health and Medical Research Council concluded that “there are no health conditions for which there is reliable evidence that homeopathy is effective”, but Europe currently spends €1bn annually on such remedies - often at the recommendation of doctors. So a recent head to head debate in The BMJ asks, should doctors recommend homeopathy? Peter Fisher, director of research, Royal London Hospital for Integrated Medicine argues yes, and Edzard Ernst, emeritus professor of complementary medicine at the University of Exeter argues no. Read their full arguments: http://www.bmj.com/content/351/bmj.h3735

Many doctors may believe that acute rheumatic fever is a disease of the past, but it's estimated that, worldwide, there are 500,000 new annual cases, and that 15 million have chronic rheumatic heart disease. Rachel Helena Webb, paediatric infectious diseases specialist at the Starship Children’s Hospital in Auckland, joins us to discuss diagnosis and management of this condition. Read the full clinical review: http://www.bmj.com/content/351/bmj.h3443

Read the full analysis: http://www.bmj.com/content/351/bmj.h3021 The prevalence and mortality of chronic obstructive pulmonary disease (COPD) is increasing globally. However, Martin Miller, honorary professor of medicine at the University of Birmingham, and Mark Levy, GP with a special interest in respiratory medicine, argue that the GOLD (Global Initiative for Obstructive Lung Disease) criteria used for diagnosis may be leading to misdiagnosis.

The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) has been examining the treatment of acute GI bleeds in England's NHS. Two of the authors, Martin Sinclair, consultant surgeon, and Simon McPherson, consultant vascular radiologist, join us to talk about their findings. Read the full report: http://www.ncepod.org.uk/gih.htm Read The BMJ news story: http://www.bmj.com/content/351/bmj.h3488